Reliability, validity, and feasibility of the objective structured clinical examination in assessing clinical skills of final year surgical clerkship

To report our experience with measurements of the objective structured clinical examination [OSCE] conducted for the final surgical clerkship year. A pilot study of the OSCE was conducted on 64 students split over 2 consecutive days lasting 160 minutes each day in May 22-23, 2005 at the Department of Surgery, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia. There were 24 actual stations in day one and 22 in day 2, consisting of combinations of history taking/communication skills, physical examination skills, and problem solving skills. The stability of the OSCE measured by Cronbach's alpha on day one was 0.68 and 0.79 on day 2. The internal consistency of the OSCE measured by Carmine's theta on day one was 0.79 and 0.81 on day 2. Credibility and comprehensiveness of the OSCE were considered good by both staff and students. Accuracy of the OSCE measured by Pearson's correlation with the MCQs was 0.5. The OSCE proved to be reliable, and a valid format for testing the clinical skills of final surgical clerkship year. Feasibility of the OSCE can be further improved with experience, repetitions, and use of standardized patients

Clinicopathological pattern of malignant parotid gland tumors in Saudi Arabia

To report our experience of varied presentations and diverse histopathological spectrum of parotid gland malignancies. This retrospective analysis incorporated patients with histological evidence of malignant parotid tumors at King Khalid University Hospital, Riyadh, Saudi Arabia over a 20-year period from 1984 through 2004. The medical records of these patients were analyzed for their demographic characteristics, clinical features, operations performed, and pathological diversity. Thirty-two patients comprised this study group. There is a male preponderance over females with a ratio of 2.2:1 22 men and 10 women and mean age of 51.8 range 28-81 years. A painless lump was the most frequent clinical manifestation observed in 23 71.8% patients followed by facial nerve dysfunction in 14 43.7% patients. Parotidectomy was performed in 22 68.7% patients: 16 superficial and 6 total. A partial facial nerve sacrifice was undertaken in 14 43.7%, and total nerve sacrifice in 9 28.1% patients. Four 12.5% patients presented with cervical lymph node metastases necessitating radical neck dissection. Nine 28.1% patients had mucoepidermoid carcinoma, 8 25% adenoid cystic carcinoma, 6 18.7% adenocarcinoma, not otherwise specified, and 2 6.2% were reported to have carcinoma in pleomorphic adenoma. Twenty 62.5% specimens revealed high-grade aggressive lesions, and out of these, 19 59.3% patients presented with stage III/IV disease. Malignant parotid tumors are exceedingly rare, occurring at a relatively earlier age group with male preponderance, and invariably declare at a late clinical stage in our community. Histopathological features hallmark a locally advanced disease with an aggressive behavior

Outpatient pilonidal sinotomy complemented with good wound and surrounding skin care

To describe an improved method for treating pilonidal sinus disease. An outpatient procedure involves laying the pilonidal sinus tract open under local anesthesia, removal of hair and debris, curettage of granulation tissue, with subsequent daily dressing, weekly shaving, and let it heal by secondary intention. The medical records of 100 patients underwent this procedure were studied regarding complications, healing time, and recurrence. This study was carried out at King Abdul-Aziz Medical City, Riyadh, Kingdom of Saudi Arabia, between January 2000 and December 2003. Ninety-five patients [95%] were males and 5 patients [5%] were females. The mean age was 21.7 years. Almost all patients who underwent the procedure were discharged after the procedure. Complications included 2 cases [2%] of bleeding, one case [1%] of vasovagal attack requiring admission overnight, 10 cases [10%] of delayed healing, and 2 cases [2%] of recurrence after an average of one year from complete wound healing. Ninety patients [90%] had completed healing after one month of daily dressing and 10 patients [10%] after 2 months. Outpatient pilonidal sinotomy with good wound and surrounding skin care is an ideal approach with high chance of cure